IDz Block 3 Cram Flashcards by brandon lovin

What happens during the prodromal period of rabies infection?

What occurs during the acute neurological period?

What finding during the neurological period is pathgnomonic

Virus enters CNS
Pain/paresthesia= pathognomonic Dx

Furious rabies
Paralytic rabies

Hydrophobia
Aerophobia

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What is the passive immunization for rabies Tx

How often is rabies booster recommended?

HRIG 20IU/kg in gluteus away from bite

CDC- 2yrs
WHO- 1yr for oversea operators

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What may be the first sign of septic arthritis in PTs w/ RA?

What are the two types of osteomyelitis

Septic bursitis

Acute/Chronic
Acute- w/in 2wks bacteria deprive bone of blood, causing necrosis

Chronic- repeat infections and dec blood supply prevent ABX reaching site

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What ABX is used for PTs w/ osteomyelitis after nail punctures through shoes?

Define Rickettsiae orgnaism

Cipro

Between bacteria/virus, obligate intracellular Gram-neg coccobacilli

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What ABX is used for PTs w/ osteomyelitis after nail punctures through shoes?

Cipro

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Since Rickettsiae don’t stain well w/ gram stain, how are they stained for identification?

Rickettsiae are usually transmitted to humans by arthropods except for ?

Red w/ Giemsa

Q fever

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Rickettsial Dzs have ? commonalities?

Different types of Rickettsial Dzs

Dx w/ serology/PCR
Rash
Zoonotic
Involve endothelial lining
Tx w/ Doxy

Brill Zinsser
Louse borne
Murine Typhus
RMSF
Q-fever

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Louse Borne Typhus is caused by ? and transmitted by ?

This form is becoming resistant to Doxy in Thailand, what med is used now?

Caused- R Prowazekii
Carried- P Humanus

Azithromycin

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How does Louse Borne Typhus present?

What is the sequence of the rash progression?

Intractable HA
Rash from trunk to extremities (opposite of RMSF), spares face palms soles

Macules Maculopapules Petechiae

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? is a relapsing louse borne typhus

How does it present

Brill Zinsser

Fever Transient rash HOTN

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M Typhus is AKA ?

What causes this strain?

What is it’s carrier?

Endemic/Flea borne typhus

R Typhi

Rat flea

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What is the biggest differential between Murin and Louse borne typhus?

What causes RMSF?

What is it’s carrier?

Brill Zinsser

R Rickettsii

Wood/dog ticks

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What is the day to day progression of a Rickettsial Dz

1-2: abrupt high fever/HA

2-4: rash on wrist/ankle, spreads centrally

5-7: high fever, rash become petechial involving palms/soles

7-9: digit necrosis, death AMS

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What will lab results of Rickettsial Dz show?

How is it Tx?

HypoNa
Inc transaminase
Thrombocytopenia

Doxy, best if started <5 days of Sxs

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What causes Q-fever

This has been re-classified as a ? microbe

C Burnetti

Proteobacteria

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What is the mainstay of Dx Rickettsial Dzs

What causes Lyme Dz

What is it’s carrier?

Serology cross reactivity

Spirochete- B burdorgeri

Ixodes- deer tick

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What is the characteristic PE finding of Lyme Dz

What are the S/Sxs of early disseminated Lyme dz

Lyme Dz can cause ? manifestations of cranioneuropathy

Erythema Migrans

Multiple EMs
Meningismus= eseptic meningitis
Carditis- AV blocks

CN7, Bells

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If Lyme Dz PT develops late dz arthritis, how does it start out

What joints are most to least likely affected

Most PTs exhibit these Sxs within ?mon of Erythema Migrans and resolve w/in ?

Migratory polyarticular process

Knee Ankle Wrist

6mon
10yrs

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If Lyme Dz PT develops late dz arthritis, how does it start out

What joints are most to least likely affected

Most PTs exhibit these Sxs within ?mon of Erythema Migrans and resolve w/in ?

Migratory polyarticular process

Knee Ankle Wrist

6mon
10yrs

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What are 3 possible long term outcomes that can arise from late Lyme Dz arthritis

If PT has Lyme and is pregnant, what meds are not used?

How should these PTs be educated?

Meningoencephalitis
Fibromyalgia
Chronic fatigue
Chronic neuropathy

Doxy
Tetracyclines

No birth defect, risk of still birth

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How is Lyme Dz Tx

Bite w/ engorged tick: Doxy
Arthritis: Doxy
Palsy: Doxy

Tick, non-endemic: no Tx

Erythema Migrans: Doxy/Amox
Carditis: Doxy/Ceftriax

Meningitis: Ceftriax

Pregnant: Amoxicillin

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How is Lyme Dz Tx

Bite w/ engorged tick: Doxy
Arthritis: Doxy
Palsy: Doxy

Tick, non-endemic: no Tx

Erythema Migrans: Doxy/Amox
Carditis: Doxy/Ceftriax

Meningitis: Ceftriax

Pregnant: Amoxicillin

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How is encephalitis Dx

What sample is essential for Dx

Head CT w/ and w/out contrast but before LP

CSF

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Where does HSV lie dormant prior to causing HSV encephalitis

How does the virus reach the CNS

This form of latent HSV is not associated w/ ?

Trigeminal ganglia

Olfactory tracts

Cold sores

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Where does HSV lie dormant prior to causing HSV encephalitis How does the virus reach the CNS

Trigeminal ganglia Olfactory tracts

What are the subacute form of HSV Encephalitis This can also produce ? inconvenient issue?

Anterior opercular syndrome- benign recurrent meningitis, loss of facial/chewing muscles HSV-1: brainstem encephalitis HSV-2: encephalitis induced myelitis Global aphasia

How is encephalitis Dx How is it Tx

PCR CT- low density lesions in temporal lobes on day 3-4 Acyclovir

Majority of Arbovirus encephalitis is ? type How does Arbovirus encephalitis present differently? What will be seen on labs?

West Nile Dys/pyuria Seizures Movement d/o Leukocytosis EEG changes

Majority of Arbovirus encephalitis is ? type How does Arbovirus encephalitis present differently?

West Nile Dys/pyuria Seizures Movement d/o

How does West Nile Encephalopathy present? How is it Dx

Extreme lethargy Flaccid paraylsis Leukpenia and serology

What are the 3 major pathways meningitis establishes an infection? What 3 microbes cause bacterial meningitis What microbe causes meningitis in adults and kids?

Bloodstream Retrograde neuron pathway Direct spread H Influenza N Meningitidis S Pneumoniae S Pneumoniae

What meningitis triad presents in most PTs What do PTs present w/ if there is cerebellar dysfunction

Fever AMS Nuchal rigidity Lethargy Confusion Coma

What are the two PE tests for meningitis How do geriatric PTs w/ meningitis present differently What is a subtle Sx of meningeal infection that may be seen?

Kernig Brudzinski Lethargic, no meningeal Sxs Neutropenia

What are the two PE tests for meningitis

Kernig | Brudzinski

How is Step Pneumo meningitis Tx What vaccine prevents this?

Cefotax/Ceftriax + Vanc + Dexameth PCV 13

What is the MC causes of meningitis in neonates How is Step Pneumo meningitis Tx What vaccine prevents this?

GBS E Coli Listeria monocytogenes Cefotax/Ceftriax + Vanc + Dexameth PCV 13

What type of microbe is N Meningitidis What presenting finding does it have and puts PTs at risk for ? What PT population is more susceptible to being infected?

Gram neg diplococcus Petechial rash Amputations Asplenic

How many serogroups of N Meningitidis are there? Which one is more common in the US than out of it How are they Tx

A B C W X Y B Cefotax or Ceftriax + Vanc + Dexameth

What is the criteria for close contact of N Meningitidis What meds are used for post-exposure prophylaxis

>8hrs of contact <3ft away Direct PO secretion exposure W/in 1wk before Sx onset Ceftriaxone 250mg IM x 1or Rifampin 500mg PO bid x 4 Cipro 500mg PO x 1

What is the criteria for close contact of N Meningitidis What meds are used for post-exposure prophylaxis

>8hrs of contact <3ft away Direct PO secretion exposure W/in 1wk before Sx onset Ceftriaxone 250mg IM x 1or Rifampin 500mg PO bid x 4 Cipro 500mg PO x 1

What are the 5 types of fungal infections that can cause meningitis What are the two 'special' causes

``` C neoformans C immitis B dermatidis Candidiasis H capsulatum ``` TB Syphilis

What are the 3 proteinaceous infections? What is an odd method of acquiring prion related Dzs

Kuru Jakob Bovine spongiform Inherited

When do prion dzs present How are these dzs Dx

6-7th decade as progressive dementia MRI- bilateral areas of increased density CSF- inc protein

What is the MC microbe in cat bites? What is the MC microbe in dog bites?

Pasturella multocida Capnocytophaga conimorsus

What microbe causes CSDz This microbe is the MC cause of ? in Peds It is also the MC cause of ? Sx

Bortonella henselae in fleas Chronic adenopathy Regional adenopathy

What is the classic presentation of CSDz What nodes are most likely to present w/ lymphadenitis Half of PTs can present w/ ? odd presentation

Rash Lymphadenitis Axillary Cervical submandibular preauricular Single node involvement

Atypical presentations of CSDz can present as ? CSDz manifestations may be slow to appear and take ? long to disappear

Encephalitits +12mon

How is CSDz Dx confirmed How is it Tx

Serology Sx therapy Azithromycin

What causes Toxoplasmosis How is this infection transported and disseminated

Toxoplasma gondii Transport- lymphatics Disseminated- hematogenously

How does Toxoplasmosis kill AIDS PTs What does it present like in healthy PTs? What is the MC congenital presentation

Encephalitis- MC manifestation Mono-like Chorioretinitis

How is Toxoplasmosis Dx What are the four atypical mycobacteriums

Organisms in any fluid/tissue CT if cerebral Amniocentesis 20-24wks if congenital Marinum Ulcerans Leprae Chelonae

M Marinum rarely causes systemic infections except for in ? PTs If deeper involvement occurs, how can this present?

ImmComp Tenosynovitis Septic arthrits

How is M Marinum Dx PTs w/ this can have what issue during PHA?

Culture 25-32*C/77-89.6*F Photochromogenic- white in darkness, yellow in light False Pos on PPD

How is M Marinum Tx M Ulcerans is AKA ? Ulcer and is found where?

Clarithromycin/Rifampin + Ethambutol x 6mon Buruli from Africa/Australia

M Ulcerans is the MC ? How is it Dx How is it Tx

3rd MC mycobacteriosis of humans after TB and Leprosy Acid fast smear PCR Rifampicin and Clarithromycin/Moxifloxacin x 8wks w/ debrisment/grafts

M Leprae is AKA ? Dz How is this transmitted

Leprosy, Hansen Dz Respiratory from foot pads of armadillos

How will PTs w/ M Leprae present What finding is highly suggestive of this Dx

Ulcer w/ dec sharp/dull sensation Ulnar neuropathy

How is M Leprae Dx How is it Tx

Skin biopsy/Nasal scrapings- acid fast bacilli Rifampin Dapsone and Clofazimine x 12mon

M Chelonae is associated w/ ? animals? This infection is associated w/ ? hobby?

Frogs/Turtles Tattoos

How does M Chelonae present How is this Tx

Plaques Erythema Violaceous Edema Tobracycin or Clarithromycin x4-6mon if deep

What is the MC zoonosis in the world? This is now considered a ? in travelers How is this infection acquired?

Spirochetes of Leptosporosis Emerging disease Contact/exposure to infected soil/water/animal

What are the two syndromes from a Leptospirosis infection The type of infection a PT will develop depends on ?

Anicteric lepto- mild flu-like Icteric- Weil Dz, organ failure Serovar involvement

What are the classic findings of Weil Dz (Leptospirosis) How are Leptospirosis infections Dx How is the extent of organ involvement assessed?

Calf/Lumbar muscle pain Isolation from tissue/fluid, typically urine CBC Liver panel Coag studies

How are in/out PT Leptospirosis infections Tx Define Protozoa

In- IV PCN G Out- PO Doxy Motile, unicellular, eukaryote

What are the 7 types of Protozoa infections

Giardiasis Crypto Toxo Malaria | Lesihmaniasis Amebiasis Babesiosis

What causes Amebiasis What can this cause to develop within the body? What effect does the microbe have on tissues?

Entamoeba Histolytica Liver abscess, M>F Induces self destruction Trophozoites colonize in colon

Amebiasis can present w/ ? How does liver abscess present differently than a single abscess If PT is Dx w/ Amebiasis, what will they probably have in their MedHx

Amebic colitis Fistulas, rectovaginal Liver- pain, no fever Single- weight loss Dysentery

How does Amebic Colitis present How does Amebic Liver abscess present

Heme +stool Fever Weight loss Diffuse abdominal tenderness ``` Hepatomegaly Jaundice Fever Weigh loss RUQ tenderness ```

How is Amebiasis Dx How does this look on US How does it look on CT

EPP PCR Homogenous hypoechoic round lesion Round low attenuation lesion w/ enhanced rim

How is Amebiasis Tx

Tissue Tx: Metronidazole Tinidazole Lumen Tx: Iodoquinol Paromomycin Surgery for fulminant amebic colitis

What is the MC parasite identified in stool specimens Why/how does this cause malabsorption How is it Dx and Tx

G Lamblia Alters epithelial function Causes villous atrophy Cytopathic secretion EPP PCR Tinidazole Metronidazole

What are the two sub-acute infections of cutaneous leishmaniasis What is the carrier of Leishmanisis

Leishmaniasis recidivans- prolonged relapsing form Post kala azal dermal Leishmaniasis Lutzomyia longipalpis- Sand flies

How does cutaneous Leishmaniasis present What is the Wet Pizza What is the Dry

Raised edge, central crater w/ regional lymphadenopathy Wet- L Major Dry- L Tropica

Visceral Leishmaniasis is AKA ? and can present w/ ? rash Where does it infect in the body?

Kala azar or Black Fever Malar Liver Spleen Marrow Spleen bigger than liver

What PE finding is characteristic of Visceral Leishmanisis? What is a common lab result?

Darkening of skin Pancytopenia

How is Leishmanisis Ds What are the criterias for Mild Leishmanisis

Tissue isolation, Giemsa stain < 4 lesions None >5cm None on sensitive areas No joint involvement

How is mild Leishmanisis Tx How are other cases Tx

Paromomycin Liquid N2 Impavido- Txs all forms Fluconazole- cutaneous Amphotericin B ThermoMed radio frequency heat

What are two rare PE findings during a Crypto infection? How is it Dx How is it Tx

Icterus Ascites EPP PCR Nitazoxanide ImmComp- HARRT therapy

What causes Babesiosis It's transmitted by ? and produces a ? What type of microbe is this

B microti- US B divergens- Europe Tick vectors, malaria-like illness Intraerythrocytic protozoan

Babeiosis Sxs are due to ? What are the presenting Sxs

Secondary to RBC parasitims Paroxysmal malaria Fatigue- depends on hemolytic anemia

? PT population has a worse prognosis if they contract Babesiosis How can it be transmitted between humans?

Asplenic In utero Blood transfusion

How is Babesiosis Dx What lab finding is pathognomonic How is it Tx

Wright/Geimsa stain Maltese cross IgM IFA titer 1:64 Atovaquone + Azith Clinda + Quinine- if severe Exchange transfusion

What causes malaria? Define Archaic Majority of malaria deaths are due to ? strain

Plasmodium, carried by Anopheles Bad/foul air, miasma P Falciparum

Of the 156 types of malaria, which ones infect humans

P falciparum P vivax P ovale P malariae P knowlesi- Simian malaria; recently found in SE Asia

What are the 4 factors that determine malaria occurrence Which strain is most wide spread Which one is primarily in tropical west Africa? Where are the two remaining found?

Climate- >77*, <6Kft Human Anopheles Parasite Vivax Ovale Falci/Malaria- sub/tropics

What form of malaria resides during the liver phase? What occurs during the erythrocyte phase?

Sporozoites Rupture of infected RBCs= fever/merozoite release

What forms of malaria have a hypnozoite form that lingers for months? Why are these two commonly seen reoccurring later?

Vivax, Ovale Failure to Tx hypozoites

What are the incubation periods for the different strains of malaria Which one doesn't have a hypnozoite stage which means this one will cause ?

Falciparum 12d Vivax 14d Ovale 17d Malariae 28d Malariae, prolonged erythrocytic infection

How long are the paroxysms between the different types of malaria What is the sequence of a malaria febrile attack Why are these sequences important

48hrs: Falci Vivax Ovale 72hrs: Malariae Cold x 15-60min Hot x 2-6hrs- HA Sweat x 2-4hrs Blood draw during fever spike, highest parasite load

Why is M Facliparum so bad?

Microvascular sequestriation Dz Hyperparasitemia >250K/5% Targets all RBCs while other strains target reticulocytes Dec Hgb/Hct x 8-10% in 48hrs

What are 4 severe manifestations of malaria What forms can cause splenic rupture in pregnant PTs

Cerebral malaria Severe anemia- Falciparum Renal failure- Malariae Pulmonary edema Vivax/Ovale

What lab result is absent in malaria infections What lab results indicate a poor prognosis

Eosinophilia ``` Cr >3mg Acidosis <15mm Jaundice, total bili >2.5 Lactate >5mm Glucose <40 Aminotransferase 3x inc ```

What hematological features of malaria indicate poor prognosis How is malaria Dx

Parasitemia 5% or more neutrophils w/ malaria pigment Thin and Thick smears 12-24hrs apart

What is the different benefits of thick/thin smears when Dx malaria What is the alternate Dx form for malaria

Thick- sensitive Thin- speciation Dipstick- LDH of Falciparum BinaxNOW for Falciparum, Vivax but neg reads must be confirmed w/ thick/thins

BinaxNOW rapid malaria tests have hard time maxing Dx if strain of malaria has low amounts of ? Ag Why are malaria prevention methods not adhered to by PTs

HRP2 GI s/e Forget Low perception of risk

What meds are used pre/post-return from malaria country

Doxy- s/e sun burns Atovaquone/proguanil- 7d post Primaquine- 14d post/terminal Chloroquine- CNS side effects Tafenoquine

What drug is used for malaria PART What drugs are used for eradicating Vivax/Ovale liver stages? What drug is used if these lead to relapse?

Primquine for P Vivax relapse Primaquine phosphate Tafenoquine

What drugs are used as uncomplicated malaria Tx if it's chloroquine sensitive What drugs are used if it's chloroquine resistant

Aralen- chloroquine phosphate Quinin sulfate + Doxy Malarone- atovaquone proguanil Coartem- artethemere lumefantreine

What drugs are used for Tx of P Falciparum What monitoring is done while Tx malaria What monitoring result indicates Tx isn't working

IV Artesunate Smears q6-12hrs Load doesn't fall x 75% in 48hrs, Blood not parasite clear in 7 days

What medication is avoided in Tx of certain malaria What strain is more likely to reinfect? What strain is more likely to have low level infection?

Steroids, worsen cerebral malaria Falciparum Malariae

Two times you'll see eosinophilia in lab results What are the Cestodes

Allergies Helminth infections ``` Tapeworms: Hymenolepiasis Solium Saginata Latum ```

? is the MC of all cestode infections? What is another form but less frequent

H Nana H Diminuta

How are Hymenolepiasis infections acquired? Where does it reside in the body What are two rare PE findings

F/o Villus Abdominal tenderness Urticaria

? form of Taeniasis is less frequently Sx What is the most striking feature and main Sx Migrating Taeniasis can cause ?

T solium Passing of proglottids Appendicitis Cholangitis

PE findings more common in kids/adults who have Taeniasis infections Where is Cysticercosis seen in US?

Weight loss- kids Subcutaneous nodule- adults SoCal, 10% of seizures

Asplenic PTs are more vulnerable to what 2 infections? PT presents w/ subcutaneous nodules, what Dx needs to be r/o?

N Meningitidis Capnocytophaga canimorsus Cysticercosis

What 4 microbes can cause anemia like issues

Babesiosis- hemolytic D Latum- Megaloblastic Hookworm- IDA M Falciparum

CSF findings

O W G P B: U PMN D U V/AM: N U N N TB/C: U U D U

Cestodes includes ? and how are they Tx

``` Tapeworms Hymenolepsis T Solium/ Saginata D Latum Praziquantel ``` Cystic- DOC

Trematodes includes ? and how are they Tx

Schistosomiasis- HJM P Westernmani Praziquantel F Hepatica- Triclabendazole

Trematodes are hermaphrodites except for ? Acute Schistosomiasis is AKA ? Etiology is believed to be due to ?

Schistosomas Katayama Fever- Mansoni/Japon Serum sickness reaction

What microbes are Dx w/ Giemsa stain Best way to Dx S haematobium

Babesiosis Rickettsia Leishmaniasis Urine sample between Noon-3pm

Where does F hepatica mature in the body How do human get this infection?

Bile duct Consumption of raw watercress

What do the acute/chronic phases of F hepatica represent? This has been linked to causing ? in Vietnam vets

Acute- migratory Chronic- obstruction/tumor Sxs Colangiocarcinoma

What is the MC species of the ten Paragonimus' that infect humans? What is unique about this microbe life cycle?

P Westermani Unembryonated eggs leave human Reacquired through consumption of crayfish/crabs

What are the nematodes and how are they Tx

Helminths: Strongyloides CLM Ivermectin/Albendazole ``` Hookworm Acariasis Toxocariasis Enterobiasis Trichisellosis Mebendazole/Albendazole ```

What is the MC helminthe in the world? What is the MC helminthe in the US?

Ascariasis Pinworm- E Vermicularis

What two nematodes can cause Loefflers Syndrome What is the 2nd MC nematode in the world and what are the two types?

Strongyloidiasis Ascariasis Hookworm: Duodenal/Americanus

What is the largest intestinal nematode? ? is AKA Human Pinworm How is it Tx

Ascaria lumbricoides Enterobius vermicularis Mebendazole

What is are two rare but possible consequences of Enterobiasis vermicularis infections in females? What is the MC tropically acquired dermatosis?

Appendicitis Chronic salpingitis CLM- Ancylostoma caninum

What causes Toxocariasis This can cause what two issues?

T canis- dog roundworm T cati- cat roundworm Visceral larva migrans Ocular larva migrans

Toxocariasis OLM can be mis-Dx as ? How would you differentiate between this mis-Dx and a helminthe infection?

Retinoblastoma (leukoria) OLM has hypereosinophilia

How are Trichinellosis infections acquired What are the 4 types and origins

Consumption carnivore meat Pseudospiralis- mammal/bird Nativa- arctic bears Nelsoni- African predators Britovi- Europe/Asia carnivores

How do Trichinellosis infections present? What are 3 life threatening manifestations that can occur? What is added on top of Mebendazole/Albendazole Txs?

Facial edema Fever Splinter hemorrhage Myocarditis Encephal/meningitis Pneumonia Steroids